Fertility preservation in young women: recommendations and ideas

Female fertility preservation is a procedure in which the woman's eggs are removed and frozen for preservation over time. In this way, the woman will be able to use these eggs at a later date to become pregnant, without having lost their quality over the years.

Women may decide to preserve their fertility for various reasons, such as prior to cancer treatment. However, in this article, we will focus on egg cryopreservation to delay childbearing, especially for social and work-related reasons.

Although there are many women who make the decision to preserve their fertility after the age of 30, when their desire to become a mother is already more evident, the ideal would be to freeze the eggs before the age of 30, when the woman is at her peak fertility stage.

Why delay childbearing?

In recent years there has been a considerable increase in the number of women who decide to preserve their fertility in order to become mothers in the future. The main reason for wanting to delay the arrival of a first child is obvious.

Many women today are unwilling or unable to become mothers in their early 20s. A girl in her 20s has a 25% chance of becoming pregnant if she has no fertility problems and has regular unprotected sex. On the other hand, if the woman is over 38 years old, this percentage is reduced to 3%. There is therefore an asynchrony between the optimal age to become a mother and the desired age to become a mother.

The likelihood of pregnancy decreases over the years

Some of the reasons for delaying childbearing are as follows:

• Incoporation of women into the labor market.
• Difficulty in obtaining a permanent contract and job stability.
• Study for competitive examinations, doctorates or other higher studies that imply entering the labor market at an older age.
• “Talent drain", for example, women who move abroad with the purpose of acquiring experience or better working conditions, and who decide not to have children until they can return to their country of birth.
• Lack of economic stability, rising rent and other factors that make it impossible to afford the costs of having a child.
• Lack of male partner.
• Few family reconciliation measures in the workplace, such as flexible working hours, teleworking, reduced working hours, etc.
• Women's desire to enjoy their youth without the responsibilities of having a child (traveling, going out with friends, etc.)

Why delay childbearing?

Ultimately, each woman may have her own particular reason for deciding not to have children until later in life. However, it is vitally important to be aware and well informed of the reproductive options that allow this delay in childbearing without affecting the likelihood of pregnancy.

What is the best age for egg freezing

Depending on the age at which a woman decides to preserve her fertility, the quality of her eggs will be higher or lower. Therefore, the probability of achieving a pregnancy with these eggs will also vary.

After the age of 35, female fertility decreases dramatically. The ovarian reserve begins to deplete more rapidly and, therefore, women who preserve their fertility between the ages of 35 and 40 will have fewer and poorer quality eggs.

It is very important to make women aware that the earlier fertility preservation is done, the more chances of success they will have in the future. Freezing eggs at 20 is not the same as freezing them at 30, just as preserving them at 30 is not the same as preserving them at 40.

The main handicap of this is that few women consider becoming mothers or preserving their fertility before the age of 30 or 35, either due to lack of knowledge or lack of economic resources.

Egg vitrification treatment is not cheap and most young women prefer to invest their money in other things rather than in preserving their fertility.

However, at InviTRA we insist on the importance of being well informed about all reproductive options for women, especially if you have a clear desire to become a mother at some point in your life.

Procedure

The treatment to freeze or vitrify the eggs is the same as in vitro fertilization (IVF), since in both cases the aim is to obtain a good number of eggs developed in the ovaries in order to extract them.

Therefore, the treatment steps to preserve fertility in women are as follows:

Consultation with the gynecologist

before starting the whole process it is necessary to do some diagnostic tests to know the fertility status, such as an ultrasound and a blood test.

Controlled ovarian stimulation

consists of the administration of hormonal drugs in order to provoke multiple follicular development in the ovaries and thus obtain the largest possible number of eggs.

Stimulation control

during the entire treatment, the woman will have to visit the clinic several times for ultrasound checks to verify that the ovarian follicles are growing correctly. Depending on the response, the gynecologist may make changes in the schedule of medication administration.

Beginning of the fertility preservation process

Follicular puncture

this is a very simple surgical procedure that is performed under sedation so that the woman does not feel any pain. Through an aspiration needle introduced through the vagina, the gynecologist extracts the eggs from the interior of the ovarian follicles. This procedure usually only takes about 15 minutes.

Egg retrieval and decumulation

once in the laboratory, an embryologist will inspect the follicular fluid obtained under the microscope and retrieve all the eggs. Next, it is necessary to perform an oocyte decumulation. This consists of eliminating the cells found around the eggs to leave them completely "peeled", a prerequisite for freezing.

Vitrification

this would be the last step of the procedure and requires great skill on the part of the embryologist. First, the eggs are dehydrated with cryoprotectants to avoid any damage during freezing. These are then carefully placed on a support and placed directly into liquid nitrogen at -196°C.

Process for vitrification of eggs in the laboratory

Vitrification is the most widely used method for freezing eggs and embryos today. This is a type of ultra-rapid freezing that offers very high survival rates. In addition, no ice crystals are formed, which would be detrimental to the oocytes.

If you want to know more about this procedure, you can continue reading here: What is egg vitrification and what are its advantages?

How much does fertility preservation cost?

The price of fertility preservation with egg vitrification varies from country to country. It alsodepends on the particular fertility clinic, the services included in the quote, the maintenance fee, etc. Here, we aim to give you an idea of the prices you can expect to pay:

Egg vitrification costs in the USA

As usual, prices in the USA vary enormously, depending on where and what clinic you decide upon. You can expect to pay between $5000 and $15000 for a cycle to induce, collect and freeze your eggs. These figures do include the price of the hormonal medication required. You will then need to pay the storage costs. This is about $500 per year.

Price of egg vitrification in the UK

According to the HFEA, the average price of egg collection and vitrification is approximately £3500. However, this figure does not include the hormonal medication or storage costs. These would be between £500 - £1500 for the medication and £150- £350 per year for the storage.

Cost of egg vitrification in Spain

The price of fertility preservation egg vitrification is between approximately €2,500 and €4,000, but it should be noted that hormone medication is usually paid separately. This can mean up to an additional 1,000 euros, depending on the characteristics and the necessary doses of medication.

As for the maintenance fees for the vitrified eggs, most clinics include the costs of the first year or two in the initial budget. After that, the patient will have to assume the cost of the maintenance of the frozen eggs, which is about 300-400€ each year.

Nowadays, assisted reproduction clinics are starting to offer fertility preservation programs that can be affordable for younger women. These are long-term financing programs so that the patient only pays about €30-40 per month, but for about 6-10 years.

At InviTRA we recommend you to get information about this type of personalized program in different centers in order to compare prices and conditions before deciding. If you need help with this, you can continue reading the following article: How to choose the best assisted reproduction clinic for me?

Future: IVF with vitrified eggs

When a woman wants to use her cryopreserved eggs to become pregnant, she will have to undergo IVF treatment with vitrified eggs.

The procedure is much simpler since the woman has already gone through the ovarian stimulation phase when she froze the eggs. It will only be necessary for your partner to come to the fertility clinic to leave a semen sample, unless you opt for donor sperm.

In the laboratory, the eggs will be devitrified using a very simple protocol and then fertilized with sperm using the ICSI technique (intracytoplasmic sperm injection).

Devitrification of oocytes for fertilization

The embryos obtained will spend 3-5 days in culture and, finally, the embryo transfer to the woman will be performed. Those embryos that are not transferred will be vitrified again for future attempts.

FAQs from users

Why is fertility preservation discouraged for older women?

Fertility preservation treatment is recommended for the following type of cases:

• Women with endometriosis, genetic or autoimmune diseases, or who are going to receive any chemotherapy or radiotherapy treatment.
• Patients with low ovarian reserve.
• Patients who are going to postpone childbearing.
• Patients with low ovarian reserve.
• Patients who are going to undergo ovarian surgery.

The most advisable age to perform fertility preservation is to do it before the age of 35, since from that age, the quality of the eggs decreases considerably. As a woman's age increases, the quantity and quality of eggs decreases rapidly, especially after the age of 38. Eggs from older women are more likely to have some genetic and chromosomal alteration. Therefore, women 40 years of age and older will have poorer oocyte quality and low ovarian reserve.

However, this depends on each patient, and each case must be reviewed individually, since there are older women (37-39) in whom this fertility preservation treatment can be beneficial.

Is it better to preserve eggs or embryos if I am over 35 years old?

Although the technique of oocyte vitrification has improved greatly in recent years, it still has some shortcomings and a percentage of cryopreserved oocytes may be lost upon devitrification. However, in the case of cryopreserved embryos, the possibility of losing them in devitrification is lower. Therefore, if we only look at the technical side, the answer to this question would be that it is better to cryopreserve embryos rather than oocytes.

But before making the decision to undergo IVF treatment in order to cryopreserve embryos, we must bear in mind that the objective of cryopreservation, in this situation that arises, is to postpone motherhood, and the woman or couple who wish to cryopreserve embryos must consider the possibility that their personal situation may change in the future.

In the case of couples, they must take into account that the embryos are affiliated to both parents, so that, in the event of a separation of the couple, the woman would not be able to dispose of them freely, having to obtain the consent of the man to use them, taking into account that the fruit of the gestation would be affiliated to him, that is to say, they would be his children.

In the case of single women who wish to preserve embryos generated with donated sperm, they should also consider the option of finding a partner in the future, in which case, unless they still maintain an adequate ovarian reserve, they would not be able to have biological children together.

In short, embryo cryopreservation is a technique with a better rate of results, but it is not free of future problems in the event that the woman's social conditions change when the time comes to use them.

At what age is fertility preservation recommended?

Normally, we advise fertility preservation at an age younger than 35 years old. This is because in order to consider ovarian stimulation, obtain a good result from this stimulation, and therefore to obtain a good number of vitrified oocytes (frozen in the laboratory) for future use, we have to start from an ovarian reserve that is as good as possible.

At the end of the day, ovarian reserve is closely related to age. So, the younger the patient is, the better. In principle if she is under 35 years of age, we will have a better result.

What will happen to my vitrified eggs if I get pregnant naturally and no longer need them?

Indeed, it is possible that after having vitrified oocytes, the patient may not want to use them to obtain a pregnancy. After all, vitrification of oocytes allows us to postpone the decision to become a mother with your own eggs and have the peace of mind that when that time comes, you have the same chances of getting pregnant as you have at the moment.

However, it may happen that in the end you do not need to resort to an assisted reproduction technique to achieve it and you get pregnant naturally.

Depending on the laws in your partiular country or state, there are three options for the destination of the vitrified oocytes in addition to their own use:

• Donation of the egg cells for scientific research.
• Donation of the egg cells for use in reproductive techniques in other patients.
• Apply for the termination of the preservation.

In any case, if you meet the criteria, you will choose the purpose of your eggs. Another possibility is that you want to keep the vitrified eggs for a second gestation and thus complete your desired family project. Remember that once the oocytes are vitrified, they do not deteriorate with the passage of time, remaining in exactly the same conditions as when they were vitrified.

How are eggs frozen?

Many women decide to preserve their fertility by cryopreserving their eggs for various reasons, either because they do not wish to become mothers at this time or because they are going to undergo very aggressive treatments, such as chemotherapy or radiotherapy, which may end their oocyte reserve.

Vitrification is the technique used to cryopreserve oocytes, as it has proven to be much more efficient than any other. It prevents ice crystals from forming inside the cells and destroying them. Oocyte vitrification offers better results when it is done in young women, since their oocytes have a higher quality, and therefore, more capacity to fertilize and develop good embryos. The older the age of the patient, the poorer the oocyte quality and the more anomalies.

Will I get pregnant for sure if I preserve my eggs while I am young?

No. Fertility preservation, as the name implies, is intended to preserve fertility, not to guarantee pregnancy. It is obvious that if we preserve eggs at the age of 30, we stop the woman's biological clock there and that woman can use those eggs at the age of 40 and will have a higher percentage of becoming pregnant. But no one can guarantee a pregnancy because concomitant pathologies can appear later on that can make pregnancy difficult even though we have 30-year-old eggs.

How many eggs need to be frozen?

Several studies recommend that the number of oocytes that should be stored is between 20 and 25 if the woman is under 35 years of age. If this age is exceeded, a greater number should be vitrified, since there will be fewer good quality oocytes. Although it should always be made clear to the patient that these cryopreserved oocytes will give her the possibility of performing in vitro fertilization in the future, and that she will have a high possibility of achieving a pregnancy, but this is not 100%.

Once vitrified, the eggs can be stored indefinitely.

Do you need to be thin to preserve fertility?

Not necessarily, although it is recommended to have an adequate Body Mass Index (BMI) to obtain a greater number of eggs and avoid possible risks. A normal BMI is between 18 and 25.

Women who are overweight or obese are more likely to suffer infertility, since estrogen production is affected, among other things. In addition, for ovarian stimulation in obese women a higher dose of hormones is needed to obtain a good response. There is also a greater probability of obtaining immature and poorer quality eggs.

You can find out more information in this article: Infertiilty and BMI

Recommended readings

If you want to learn about other fertility preservation methods, both in women and men, you can access the following post: Fertility preservation.

If you need more information about ovarian reserve and how age affects female fertility, we recommend reading the following article: What is ovarian reserve and how does it affect fertility?